İ. E. ERTAŞ, A. DOĞAN, A. ÖZDEMİR, U. SOLMAZ, R. GÖKLÜ, Y. YILDIRIM

The effect of adjuvant treatment modalities on survival outcomes in cytoreductive surgery performed patients with advanced stage uterine sarcomas

Amaç: Sitoredüktif cerrahi (SRC) yapılan ileri evre uterin sarkomlu hastalarda adjuvan tedavi modalitelerinin sağkalım sonuçları üzerine etkisini analiz etmektir. Gereç ve Yöntem:1/1994-1/2009 yılları arasında; merkezimizde teşhis ve tedavi edilen (n=122) uterin sarkom tanılı hastadan, n=26 (%21)i ileri (FIGO evre III ve IV) hastalığa sahipti ve bu retrospektif çalışmanın olgularıydı. Hastalığın evresi, tümör histolojisi, lenfadenektomi varlığı, sitoredüktif cerrahinin optimalitesi, adjuvan kemoterapi (KT) ve radyoterapi (RT) uygulamaları, hastalıksız ve genel sağkalım oranları ana ölçüm parametreleriydi. Veriler tanımlayıcı analizler, Kaplan-Meier and log-rank test yapılarak sunuldu. Bulgular: Histolojik olarak vakalar; 9 (%34.6) leiomyosarkom, 3 (%11.4) endometriyal stromal sarkomdan ve(%54) karsinosarkomdan oluşmaktaydı. Sistematik lenfadenektomi, sadece bilateral pelvik (n=9); bilateral pelvikparaaortik (n=17) hastaya uygulandı. Optimal sitoredüksiyon, (23/26) %88 hastada elde edildi. Adjuvan tedavi olarak sadece KT (n=10) ve RT+KT (n=16) hastaya uygulandı. (SRC+adjuvan KT)-(SRC+adjuvan KT+RT) uygulanan hasta gruplarının ortalama sağkalım süreleri sırasıyla; hastalıksız sağkalım açısından [12.642.3] ay (p

Sitoredüktif cerrahi yapılan ileri evre uterin sarkomlu hastalarda adjuvan tedavi modalitelerinin sağkalım sonuçları üzerine etkisi

Aim: To analyse the effect of adjuvant treatment modalities on survival outcomes in cytoreductive surgery (CRS) performed on patients diagnosed with advanced stage uterine sarcomas. Materials and Methods: Between the years of 1/19941/2009; among (n=122) patients with uterine sarcoma that were diagnosed and treated at our center, n=26 (21%) who had advanced (FIGO stage III and IV) disease were the subject of this retrospective study. The stage of the disease, tumor histology, presence of lymphadenectomy, optimality of cytoreductive surgery, adjuvant radiotherapy (RT) and chemotherapy (CT) applications, disease-free survival (DFS) and overall survival (OVS) rates were the main outcome measures. Data were presentedperforming descriptive analyses, Kaplan-Meier and the log-rank test. Results: Histologically, cases consist of 9 (34.6%) leiomyosarcoma;3 (11.4%) endometrial stromal sarcoma and 14 (54%) carsinosarcoma. Systematic lymphadenectomy was performed in the forms only bilateral pelvic (n = 9); bilateral pelvic + para-aortic (n=17). Optimal cytoreduction was achieved in 23 (88%) of 26 patients. Only CT (n = 10) and CT + RT (n=16) were applied as adjuvant treatments. The mean survival of patient groups on which (CRS+ adjuvant CT)(CRS+adjuvant CT+RT) were performed was determined as [12.642.3] months (p< 0.05) in termsDFS and, [21.852.8] months (p<0.01) in terms of OVS, respectively. Conclusion: Due to the low quantity of patients, different tumor types and different CT regimens, data of the treatment modalities from this particular patient setting are inconclusive, especially in terms of effectivenessadjuvant CT alone following CRS. But there is evidence for the combination of adjuvant CT and RT following CRS provides significantly higher DFS and OVS rates. Sonuç: Hasta sayısının azlığı, farklı tümör tipleri ve KT rejimleri nedeniyle bu özel hasta grubundan gelen tedavi verileri, özellikle SRCyi takiben sadece adjuvan KTnin etkinliği açısından bir sonuca ulaşmamıştır. Fakat SRCyi takiben adjuvan KT+RT kombinasyonunun anlamlı derecede yüksek hastalıksız ve genel sağkalım oranları sağladığına dair kanıt bulunmaktadır.

PDF

___

1. Yildirim Y, Inal MM, Sanci M, Sentas A, Hanhan M. Uterine sarcomas: A 10-year experience and a review of the literature. The Women's Oncology 2004;4(1):7-12.
2. Nam JH, Park JY. Update on treatment of uterine sarcoma. Curr Opin Obstet Gynecol 2010;22(1): 36-42.
3. Ayhan A, Tuncer ZS, Tanir M, Yuce K, Ayhan A. Uterine sarcoma: The Hacettepe hospital experience of 88 consecutive patients. Eur J Gynaecol Oncol 1997;18(2):146-8.
4. Piuna B, Rabinovich L, Yanai-Inbar I, Cohen Y, Glezerman M. Uterine sarcoma in the south of Israel: study of 36 cases. J Surg Oncol 1997;64(1):55-62.
5. Jonson AL, Bliss RL, Truskinovsky A, et al. Clinical features and outcomes of uterine and ovarian carcinosarcoma. Gynecol Oncol 2006;100(3):561-4.
6. Gonzalez Bosquet J, Terstriep SA, Cliby WA, et al. The impact of multi-modal therapy on survival for uterine carcinosarcomas. Gynecol Oncol 2010;116(3):419-23.
7. D'Angelo E, Prat J. Uterine sarcomas: a review. Gynecol Oncol 2010;116(1):131-9.
8. Tanner EJ, Leitao MM Jr, Garg K, et al. The role of cytoreductive surgery for newly diagnosed advanced- stage uterine carcinosarcoma. Gynecol Oncol 2011;123(3): 548-52.
9. World Health Organization classification of tumours. In: Tavassoli FA, Devilee P, (eds). Pathology and genetics of tumours of the breast and female genital organs. Lyon: IARC Press; 2003.
10. Villena-Hensen C, Diesing D, Fischer D, et al. Carcinosarcomas-a retrospective analysis of 21 patients. Anticancer Res 2006;26(6C):4817-23.
11. Aksoy S, Hızlı D, Sarıcı S, Öcalan R, Köse MF, Güler N. A retrospective review of metastatic and recurrent uterine sarcomas treated with Ifosfamide and Doxorubucin (IMA). UHOD 2008;18(3):129-34.
12. Hensley ML, Blessing JA, Mannel R, Rose PG. Fixed-dose rate gemcitabine plus docetaxel as first-line therapy for metastatic uterine leiomyosarcoma: a Gynecologic Oncology Group phase II trial. Gynecol Oncol 2008;109(3):329-34.
13. Hensley ML, Ishill N, Soslow R, et al. Adjuvant gemcitabine plus docetaxel for completely resected stages I -IV high grade uterine leiomyosarcoma: results of a prospective study. Gynecol Oncol 2009;112(3):563-7.
14. Hardman MP, Roman JJ, Burnett AF, Santin AD. Metastatic uterine leiomyosarcom regression using an aromatase inhibitor. Obstet Gynecol 2007;110(2 Pt 2):518-20.
15. Amant F, De Knijf A, Van Calster B, et al. Clinical study investigating the rol of lymphadenectomy, surgical cas tration and adjuvant hormonal treatment in endometrial stromal sarcoma. Br J Cancer 2007;97(9):1194-9.
16. Kapp DS, Shin JY, Chan JK. Prognostic factots and survival in 1396 patirnts with uterine leiomyosarcomas: Emphasis on impact of lymphadenectomy and oophorectomy. Cancer 2008;112(4):820-30.
17. Berchuck A, Rubin SC, Hoskins WJ, Saigo PE, Pierce VK, Lewis JL Jr. Treatment of uterine leiomyosarcoma. Obstet Gynecol 1988;71(6 Pt 1):845-50.
18. Gadducci A, Landoni F, Sartori E, et al. Uterine leiomyosarcoma: analysis of treatment failures and survival. Gynecol Oncol 1996;62(1):25-32.
19. Nam JH. Surgical treatment of uterine sarcoma. Best Pract Res Clin Obstet Gynaecol 2011;25(6):751-60.
20. Nemani D, Mitra N, Guo M, Lin L. Assessing the effects of lymphadenectomy and radiation therapy in patients with uterine carcinosarcoma: A SEER analysis. Gynecol Oncol 2008;111(1):82-88.
21. Ramondetta L, Bodurka D, Deavers M, Jhingran A. Uterine sarcomas. In: Eifel PJ, Gershenson DM, Kavanagh JJ, Silva EG (eds). MD Anderson Cancer Care Series, Gynecologic Cancer; New York 2006:125-47.
22. Gadducci A, Cosio S, Romanini A, Genazzani AR. The management of patients with uterine sarcoma: A debated clinical challenge. Crit Rev Oncol Hematol 2008;65(2):129-42.
23. Weitmann HD, Knocke TH, Kucera H, Pötter R. Radiation therapy in the treatment of endometrial stromal sarcoma. Int J Radiat Oncol Biol Phys 2001;49(3):739-48.
24. Clayton Smith D, Kenneth Macdonald O, Gaffney DK. The impact of adjuvant radiation therapy on survival in women with uterine carcinosarcoma. Radiother Oncol 2008;88(2):227-32.
25. Reed NS, Mangioni C, Malmström H, et al. European Organisation for Research and Treatment of Cancer Gynaecological Cancer Group: Phase III randomized study to evaluate the role of adjuvant pelvic radiotherapy in the treatment of uterine sarcomas stages I and II: an European Organisation for Research and Treatment of Cancer Gynaecological Cancer Group Study (protocol 55874). Eur J Cancer 2008;44(6):808-18.
26. Bokhman JV, Yakovlera IA, Urmanchejera AF. Treatment of patients with sarcoma of the uterus. Eur J Gynaecol Oncol 1990;11(3):225-31.
27. Park JY, Kim DY, Suh DS, Kim JH, Kim YM, Kim YT. Prognostic factors and treatment outcomes of patients with uterine sarcoma: analysis of 127 patients at a single institution, 19892007. J Cancer Res Clin Oncol 2008;134(12):127787.
28. Sutton GP, Blessing JA, Barrett RJ, McGehee R. Phase II trial of ifosfamide and mesna in leiomyosarcoma of the uterus: a Gynecologic Oncology Group Study. Am J Obstet Gynecol 1992;166(2):556-59.
29. Sutton G, Brunetto VL, Kilgore L, et al. A phase III trial of ifosfamide with or without cisplatin in carcinosarcoma of the uterus: a Gynecologic Oncology Group Study. Gynecol Oncol 2000;79(2):147-53.
30. Homesley HD, Filiaci V, Markman M, et al. Phase III trial of ifosfamide with or without paclitaxel in advanced uterine carcinosarcoma: A Gynecologic Oncology Group Study. J Clin Oncol 2007;25(5):526-531.
31. Makker V, Abu-Rustum NR, Alektiar KM, et al. A retrospective assessment of outcomes of chemotherapy-based versus radiation-only adjuvant treatment for completely resected stage I-IV uterine carcinosarcoma. Gynecol Oncol 2008;111(2):249- 54.